1. D. Kiagiadaki, V. Bachy, M. Remacle, S. Van Der Vorst, G. Lawson
Efficacy of LPR diagnosis with the oropharyngeal pH monitoring system: retrospective data of a 2 years’ study.
D. Kiagiadaki, V. Bachy, M. Remacle, S. Van Der Vorst, G. Lawson
Laryngology - Head & Neck Surgery Unit, Department of ENT-Head & Neck Surgery, of Louvain University Hospital of Mont Godinne, Belgium.

2. Introduction-Background
LPR different entity from GERD (Koufman, 2006)
Suspicion of LPR: clinical history, findings and symptoms.
Diagnostic strategy in clinical practice (Ford, 2005)
Multichannel impedance and pH monitoring
TNE or EGD While EGD reveals esophageal lesions in 50% of typical GERD patients, it is abnormal in less than 20% of LPR laryngitis (Vaezi, 20004)
Manometry
Barium
Accuracy in oropharyngeal environment??
24 – hour oropharyngeal pH monitoring system (liquid and aerozolized acid levels measurement)
Kiagiadaki et al ORL-HNS Nice 2013

3. Patients and methods Retrospective study: 11/2010-11/2012
65 patients (31 females, 34 males)
mean age 51.5 years.
24-hour oropharyngeal pH monitoring with the Restech Dx-pH SystemTM
Indications:
Presence of ENT signs and/or symptoms of LPR
pharyngo-laryngeal symptoms (32.3%)
pharyngeal (27.7%)
globus pharyngeus/throat clearing/chronic cough
laryngeal symptoms alone (24.6%)
Other (3.1)
Diagnosis Efficacy of treatment
Analysis after the extraction of meals according to mean pH values and the RYAN score.
Kiagiadaki et al ORL-HNS Nice 2013

4. Results (1): RYAN score and pH values
Cut off pH values:
: mild
: moderate
<5.5: severe
58.5% of patients: severe reflux
-36% upright
-15% supine
-47% both
Mean pH value in patients with pathol. RYAN score: 6.4(+/- 0.4)
Kiagiadaki et al ORL-HNS Nice 2013

5. Kiagiadaki et al. ORL-HNS Nice 2013
Results (2)
Gastroscopy in 33 patients: 27 before/5 after
3/5 patients with normal double probe pHmetry: severe reflux
52 patients under treatment
11 normal severe mild - moderate reflux
GASTROSCOPY RESULT
Total
NORMAL
OESOPH.A
OESOPH.B
BARRET
HERN.HIATAL NON COMPL.
SEVERE REFLUX (RYAN SCORE)
YES 8 3 1 13 NO 5 4 20 16 33
UNDER TREATMENT 14 7 30
Kiagiadaki et al ORL-HNS Nice 2013

6. Kiagiadaki et al. ORL-HNS Nice 2013
Conclusions
Mean pH values alone could not predict the severity of reflux.
The number and duration of acidity episodes indicated the severity of reflux (RYAN score).
Oropharyngeal 24-hour pH monitoring was proven a useful method for the accurate diagnosis of LPR, confirming either the need or the effectiveness of medical treatment.
Kiagiadaki et al ORL-HNS Nice 2013

7. Discussion - Prospectives
Advantages of oropharyngeal pH monitoring over 24 – hour double probe pHmetry: accuracy and tolerance.
Lacking prospective randomized studies of its efficacy for extraesophageal reflux diagnosis/ efficacy of PPIs treatment.
Kiagiadaki et al ORL-HNS Nice 2013